The amount and content of medical student teaching in the operating room and its alignment with clerkship goals was unknown.A qualitative research design using field observations, followed by qualitative and quantitative data coding and analysis.A mean of 9.8% of the total case time (range 1.6%-20.2%) was spent teaching clerkship goals. Teaching strategies based on basic principles of learning were used during a mean of 66% of the total case time (range 30%-99%). The most common teaching strategy was active student participation (28%) followed by command (14%) and lecture (13%). Educational experience in the OR was rated 4.0 (out of 5) by faculty and 3.3 by students. No correlation existed between student satisfaction and time actively participating in the operation or time spent teaching to clerkship goals (P = .66, P = .95, respectively).Teaching in the OR is more focused on technical aspects of the operation than the goals of a core surgery clerkship.